Abstract
BackgroundLeadership and stress are common concepts in nursing, and this study explores empirically the connection between leadership and stress of conscience in the context of aged care practice. Previous literature has shown that when staff are unable to carry out their ethical liabilities towards the residents, feelings of guilt may occur among staff, which may be an expression of stress of conscience. Although leadership has been described as crucial for staff’s work perceptions of stress as well as for person-centred practices, the influence of nursing home managers’ leadership on stress of conscience among staff and person-centred practices is still not fully explored. This study attempts to address that knowledge gap by exploring the relationship between leadership, person-centred care, and stress of conscience.MethodsThis study was based on a cross-sectional national survey of 2985 staff and their managers in 190 nursing homes throughout Sweden. Descriptive statistics and regression modelling were used to explore associations.ResultsLeadership was associated with a higher degree of person-centred care and less stress of conscience. A higher degree of person-centred care was also associated with less stress of conscience. The results also showed that leadership as well as person-centred care were individually associated with lower levels of stress of conscience when adjusting for potential confounders.ConclusionNursing home managers’ leadership was significantly associated with less staff stress of conscience and more person-centred care. This indicates that a leadership most prominently characterised by coaching and giving feedback, relying on staff and handling conflicts constructively, experimenting with new ideas, and controlling work individually can contribute to less staff stress as well as higher degree of person-centred care provision.
Highlights
Leadership and stress are common concepts in nursing, and this study explores empirically the connection between leadership and stress of conscience in the context of aged care practice
The findings of this study revealed a significant association between leadership and person-centred care, highlighting the importance of nursing home managers’ leadership because this can be interpreted as leadership having a direct impact on staff stress of conscience, and an indirect impact through influencing the development of person-centred care provision
This study provides insights that a leadership most prominently characterised by behaviours such as experimenting with new ideas, controlling work closely, relying on his/her subordinates, coaching and giving direct feedback, and handling conflicts in a constructive way is positively associated with less staff stress of conscience as well as with increased person-centred care
Summary
Leadership and stress are common concepts in nursing, and this study explores empirically the connection between leadership and stress of conscience in the context of aged care practice. Previous literature has shown that when staff are unable to carry out their ethical liabilities towards the residents, feelings of guilt may occur among staff, which may be an expression of stress of conscience. Backman et al BMC Nursing (2021) 20:200 impact of nursing home managers’ leadership on levels of stress of conscience are yet to be explored. In care, nursing home staff balance the ideals and ethical values with the various and sometimes incompatible demands from residents, colleagues, superiors, and organisations [7]. Ethical challenges such as dissonance between residents’ autonomy and a fair and equal resource distribution while still fulfilling organisational demands have been reported as a source to stress in nursing homes [6]. Negative effects of stress of conscience have been well documented with associations with high levels of emotional exhaustion and burnout among staff [12, 13], sleeping problems, and depressive symptoms [14]
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